TURP (transurethral resection of the prostate) is one of the most frequently performed procedures in urology – perhaps the most frequent – and it is widely available in almost every urology department. For many years it has been the “gold standard” for benign prostatic enlargement requiring surgery.
Although both procedures are minimally invasive – performed transurethrally, through the urinary channel – there are major differences between them. The first is the surgical approach itself: enucleation vs. resection. In TURP, the prostate is removed in small “chips” (partial resection), whereas enucleation detaches the whole adenoma from the prostatic capsule. The more tissue is removed (a major advantage of HoLEP), the greater the improvement in urinary symptoms caused by the obstruction. With HoLEP, this “radical” removal of prostate tissue from the capsule also means a durable result for the patient: a repeat operation, or the need to restart or continue medication such as tamsulosin or dutasteride, is extremely unlikely.
Another major advantage of HoLEP is reduced bleeding during surgery, as the laser seals the blood vessels at the level of the capsule. A further key difference is the size of prostate (adenoma volume) that each technique can treat. TURP is suitable for prostates up to about 80 g, while HoLEP can also be performed for very large adenomas of over 100–150 g, and remains highly effective regardless of prostate volume.
The holmium laser can also break up any bladder stones that have formed because of the obstruction caused by the enlarged prostate.
In conclusion, although both procedures are minimally invasive, HoLEP has clear advantages: more prostate tissue is removed (much better urinary flow, markedly improved symptoms, long-lasting results); it has a better safety profile (low risk of bleeding); there is no upper limit on prostate size, so it remains effective for very large adenomas that cannot be treated with TURP; and the laser can treat bladder stones at the same time (treating associated conditions in a single procedure).
